[Legislative] Bans could have the unintended consequence of deterring therapists from engaging with children who have questions or even of ensnaring good therapists when they do. … Psychotherapy is inherently private and complex, and for some individuals, sexual orientation and gender identity can and do evolve in the course of legitimate treatment.

That’s not the opinion of right-wing homophobes. It’s from a May 2, 2015 Washington Post op-ed by Stewart Adelson, an assistant clinical professor at Columbia University medical school and principal author of the American Academy of Child and Adolescent Psychiatry’s practice guidelines on LGBT youth, and Kyle Knight, a researcher in the LGBT rights program at Human Rights Watch.

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The White House, in response to an online petition that cites LGBTQ+ youth suicide in calling for a federal ban on all conversion therapy, responded with a statement saying, “While a national ban would require congressional action, we are hopeful that the clarity of the evidence combined with the actions taken by these states will lead to broader action that this Administration would support.”

It’s absurd to say that the transgender experience is all in somebody’s head or that it’s not real, or cling to the idea that it’s a mental illness out of hand. I have known transgender people both before and after their transitions and have seen them leading much happier lives.

But it’s also equally absurd to never push or poke at any individual’s claim to a transgender identity. A gender transition is a huge, huge deal, and therapists need to be able to make sure their clients hammer out their concepts of who they are before they make some very major decisions. A small number of those who pursue surgery to change their sex regret it. …

We should be more concerned that therapists would become afraid to challenge how their patients see themselves out of fear of running afoul of a government regulation telling them how to go about treatment.

The position of LGBT youth is different from that of adults, and there is a necessary role for the state in protecting youth against abusive parents (although this role, too, is often handled badly by government). As regards protecting LGBorT youth, there are some issues to be addressed. The petition states, for instance, “Therapists that engage in the attempt to brainwash or reverse any child’s gender identity or sexual orientation are seriously unethical and legislation is needed to end such practices that are resulting in LGBTQ+ deaths.”

As Shakeford suggests, the matter isn’t always so simple, particularly concerning the need to be certain of a young person’s transgender identity before life-altering changes are made. There is some convincing evidence, for instance, of prepubescent males regarded as “effeminate,” and who then self-identify as transgender, being put on hormonal therapy to stifle male sexual development by obliging parents. There is also evidence that post puberty and into adulthood, many “effeminate”-regarded (and self-regarding) boys, including some of those who had identified as transgender, maturing into gay men who are not, it turns out, transgendered and are most happy to have their male sexuality intact.

Critics of puberty blockers, now administered in at least 37 locations in the United States according to Spack, point to the expense, the numerous side-effects associated with Lupron and its pharmaceutical relatives, and the possibility that parents and physicians might be pushing children who would otherwise grow out of their transgender identities into a lifetime of painful and costly surgery, dependence on daily doses of estrogen and other hormones, and the difficulty of finding a place for themselves in a world in which their femininity will always be questioned. On top of that, taking large doses of the hormones of the opposite biological sex almost invariably renders the taker sterile.

One of the leading critics has been Kenneth Zucker, a psychologist and former colleague of Blanchard who heads the gender-identity clinic at Toronto’s Clarke Institute. “One controversy is, how low does one go in starting blockers?” Zucker told the Globe in 2011. “Should you start at 11? At 10? What if someone starts their period at 9?” Zucker prefers a therapy regimen of trying to ease transgender girls into accepting that they will be happier in the long run by accepting their genetic maleness, since most of them will grow up to be gay men anyway.

[Transgender activist] Andrea James, as might be expected, has repeatedly attacked Zucker on her website as promoting “reparative therapy for gender-variant youth”—likening him to the often religiously motivated advocates of “curing” a gay sexual orientation.

Should Zucker’s therapeutic approach be illegal?

Some forms of conversion or reparative therapy are indeed destructive when inflicted on minors. But if conversion therapy should be illegal, when does religious counseling become therapy, and at what point should the state and its social welfare network step in and override parents? Is there a risk that these practices where be driven “underground,” where they might be even more destructive?

These concerns don’t mean that states shouldn’t be scrupulous about how they license potentially harmful and abusive therapeutic practices, or that the federal government shouldn’t weigh in. Or that there are no transgendered youth. It just suggests the issues involved aren’t always so clear cut and that it will be useful to see how these state bans play out, and if they are demonstrated to be protective of at-risk youth.

More. From the comments, “Jesse” writes:

I think here, as elsewhere, the idea that T and L&G are the same issues leads to a number of problems. A very strong argument can be made that sexual orientation is inherent and thus therapeutic approaches are destructive, unscientific and should be banned. But to say that someone who hasn’t gone through puberty can be certain that they are transgender and thus should have their puberty blocked just is not the same thing. …

With so much hostility toward gay youth, I’m not surprised some find it easier to say, I’m transgendered; fix me so I fit in. And if the transgender activists say that counseling to see if maybe they are not transgendered, just gay, should be barred, that’s a problem. Fear of offending transgender activists could actually be putting gay youth at risk.

26 Comments for “Conversion Therapy Bans: Some Considerations”

Well, it seems it’s the transgender activist quoted in the referenced article who is decrying as reparative therapy the type of counseling that recommends avoiding puberty blockers for possibly transgendered (and maybe just gay) minors.

I think here, as elsewhere, the idea that T and L&G are the same issues leads to a number of problems. A very strong argument can be made that sexual orientation is inherent and thus therapeutic approaches are destructive, unscientific and should be banned. But to say that someone who hasn’t gone through puberty can be certain that they are transgender and thus should have their puberty blocked just is not the same thing. But, as noted, that seems to be what at least some transgender activists are saying.

With so much hostility toward gay youth, I’m not surprised some find it easier to say, I’m transgendered; fix me so I fit in. And if the transgender activists say that counseling to see if maybe they are not transgendered, just gay, should be barred, that’s a problem. Fear of offending transgender activists could actually be putting gay youth at risk.

This post, the referenced “articles” and Jesse’s comment show an unsurprising lack of understanding about the difference between GLB conversion ‘therapy’ which has been discredited by every reputable medical establishment and organization not tied to NARTH and the treatment of gender dysphoria.

This is a discussion that needs to take place among experts in these fields, not politicians and religious activists. We should be concerned about what is in the best interest of the people involved. Are young people actually be “pushed” into medical treatments in the way being discussed above? That would be troubling? Or is this a strawman argument from yet another bigoted group? I’m so sick of medical issues being politicized, especially by right wing idiots pushing an anti-gay and anti-trans agenda. If there are problems, lets address them but only if they are real problems and not another round of made up bullshit from the transphobic bigoted religious right. And shame in Stephen. Even for a self-loathing homocon this was disgraceful.

I don’t know if Stephen is being disingenuous, intentionally misleading or just ignorant, but his intentional conflation of conversion/reparative therapy to “pray away the gay” with hormone therapy issues surrounding gender dysphoria are sad and untrue and rather disgusting. The issues are not related.

First, conversion therapy is not just “pray away the gay.” Some of it has Freudian roots – the opposite of religious therapy.

Second, it’s the petition that puts gay conversion therapy and therapy challenging transgender ID for prepuberty kids on the same level, and the transgender activist Andrea James who said that therapy advising kids not to gender transition because they may be gay was the same as “conversion” therapy and should be banned.

As for “pray away the gay” vs Freudian therapy … really? Are there “Freudian” camps in South America where Christian parents send their children to be “repaired?” Are we awash with “Freudian” therapists at this late date trying to convince children that they aren’t really queer, it is all the fault of their overbearing mother and distant father? I think that ship sailed some time ago.

Conversion therapy — trying to turn queer poeple/kids into happy heterosexuals — is at this point pretty much the exclusive provenance of Christian fundamentalists.

There is no reputable school, discipline or medical organization that has not discredited ‘conversion therapy’ – it’s snake oil, destructive and ultimately futile… But as the Onion notes, the majority of gays in this therapy successfully convert before suicide…

@Mike: No arguments. But part of living in a (albeit dwindling) free society is that adults (NOT kids) should be allowed to make stupid decisions, as long as they don’t hold anyone else to blame for said stupid decisions.

Anyone who does even the most cursory of research will discover how ineffective and potentially dangerous conversion therapy is. Rock climbing is also dangerous. Same for skydiving, smoking, being sexually irresponsible, and yes, even consuming snake oil. But we allow adults the freedom to make those stupid decisions. We are already being over-nannied as it is. As long as adults (again, NOT kids) are making the decision of their own free will to engage in conversion therapy, I say let ’em do it.

Mike, in case you agree with me, I am just using your comment as a starting point for mine.

Re: Freudian Roots: “But Sigmund Freud challenged that prevailing theory early in his career. In his Three Essays on the Theory of Sexuality, Freud argued that if degeneracy theory were a valid explanation, it would mean that gay people who have to exhibit not many different behaviors from the norm, but their “efficient functioning” would have to be limited as well. Freud however found gay men and women who exhibited no other behavioral problems, and rather than exhibit unimpaired functioning but many were “indeed distinguished by specially high intellectual development and ethical culture.” If gay people were truly the product of degeneracy, none of his observations would make sense.

In 1935, Freud outlined some of these beliefs again in a letter which is often described as being to “an American mother” The letter has been so described perhaps because it was sent anonymously to the American sexologist Dr. Alfred Kinsey from “a grateful mother.” We don’t actually know who that mother was. Kinsey, in turn, shared it with the American Journal of Psychiatry, where it appeared in the April 1951 edition. The handwritten letter reads as follows:

April 9th, 1935.

Dear Mrs. ——

I gather from your letter that your son is a homosexual. I am most impressed by the fact that you do not mention this term yourself in your information about him. May I question you, why you avoid it? Homosexuality is assuredly no advantage but it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by a certain arrest of sexual development. Many highly respectable individuals of ancient and modern times have been homosexuals, several of the greatest men among them. (Plato, Michelangelo, Leonardo da Vinci, etc.) It is a great injustice to persecute homosexuality as a crime and cruelty too. If you do not believe me, read the books of Havelock Ellis.

By asking me if I can help, you mean, I suppose, if I can abolish homosexuality and make normal heterosexuality take its place. The answer is, in a general way, we cannot promise to achieve it. In a certain number of cases we succeed in developing the blighted germs of heterosexual tendencies which are present in every homosexual, in the majority of cases it is no more possible. It is a question of the quality and the age of the individual. The result of treatment cannot be predicted.

What analysis can do for your son runs in a different line. If he is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency, whether he remains a homosexual or gets changed. If you make up your mind he should have analysis with me — I don’t expect you will –, he has to come over to Vienna. I have no intention of leaving here. However, don’t neglect to give me your answer.

Sincerely yours with kind wishes,
Freud.

P. S. I did not find it difficult to read your handwriting. Hope you will not find my writing and my English a harder task.

It would take another four decades before the American Psychiatric Association would finally catch up with Freud’s finding that homosexuality “cannot be classified as an illness.”-Box Turtle Bulletin

I think this is just more about Stephen opposing anything that Obama does. If Obama said that sea water was salty, Stephen would argue that is was not.

I find his delving into this subject and apparently thinking LGB conversion therapy is in any way similar to medical treatment for gender dsyphoria ignorant and disgusting. A new low even for you Stephen.

I’ll be sending Stephen those flowers. He really has been working too hard.

The social right cannot be trusted to expound expertly on transgender issues. They shouldn’t be politicized at all.

Gender is a power issue. That’s why it’s so explosive. Neither the left nor the right can wait to wade in on it.

It’s even explosive in “progressive” circles. Witness how “hysterical” I’m accused of being when I make a point the boys don’t like. Blithery, dithery little female me!

And I’m a bitch. Let’s not forget that this word was used in a retort to me in the previous commentary thread. That’s the all-purpose keep-the-women-down word.

Absolutely transgender people get enough crap as it is. They don’t need government mandating certain types of treatment. If the left wants to pass a law protecting transgenders from any sort of government meddling at all, I’m all for it.

Lori — I don’t think that this is the case of government mandating types of treatment, but simply doing its job of keeping quackery out of the medical marketplace.

I think one (of many) issues for transgender persons is the lack of access to WPATH-level care… it’s just not available, even when you have the resources to pay for it (which most do not because of pernicious prejudice in the workplace)… and too often, trans people are fobbed off to therapists and clinicians who understand sexual orientation but are out of their depth when it comes to gender identity.

Sexual orientation “conversion therapy” — or “coercion therapy” — is just snake oil at best and torture at worst. If an adult person wants to avail themselves of that hokum, then caveat emptor and on your merry way. Minors should not be subjected to this dangerous quackery ever. And contra Stephen, there are no safe “conversion” therapies.

(And for the record, I disagree with you on certain issues and think you’re snarky and often wrong IMHO, but not that “term that’s not used in polite society — outside of a kennel”.)

I agree that conversion therapy is quack “science,” in whatever form it takes.

The hurdle that transgender people must overcome is in some ways very much like the one we have had to clear. People don’t understand, think it’s “all in their heads” and that they’re “mixed up,” etc.

There is a LOT of therapy transgenders have to go through before they are even permitted to think about reassignment surgery. By the time they’ve been through that wringer, they certainly do know that what they’re doing is what they need to do to be true to themselves.

Nope – I am not the type to be run off, especially by the likes of the sad LibDems on this site. I just don’t have an overabundance of free time to sit at my computer, waiting for Stephen’s latest missive so I can get that massive rush of ecstasy when I get the chance to do nothing but argue and name-call. On an unrelated matter, I’ll happily give you the name of my Dramamine dealer, as now that Hildebeast is the soon-to-be coronated Dem queen, we’ll be subjected to months of pathetic rationalizations from gay Dems on how the DADT- and DOMA-passing, wait till the polls say it’s OK to change our position on gay marriage Clintons are a good thing.

Anyhow, let’s face it, I think one thing we all can agree on is that conversion therapy on adults is ridiculous, and oftentimes, harmful. But, they are ADULTS – capable (or hopefully capable) of making their own decisions. If someone wants to spend thousands of dollars getting ice baths and praying the gay away, have at it. I see no reason why government needs to step in and “solve the problem.”

But with kids, I think it should definitely be banned. All it does is lead to misery, self-hatred and potential death, and it robs them of the fundamental right to form their own identity.

But, having said that, I also think that anything beyond talk therapy (for conversion) should be banned for trans youth. They would still be able to live their lives as their innate gender and receive the emotional support they need, while allowing them time to gain the wisdom and maturity to make such an awesome, and often irreversible decision. For good and obvious reasons, we don’t allow 14 year-olds to make adult decisions. It’s only logical to extend this to this issue. If they want to fully transition, it’ll wait till they’re 18 and have at least the beginning of a rational, adult brain.

As I understood it, the main purpose of puberty blockers was to delay the onset of puberty to give the minor more time to figure things out. I could be wrong here, but I’ve never understood it to be something done idly or without a lot of concurrence from the child, the parents, the therapists and the doctors.

That said…

“Zucker prefers a therapy regimen of trying to ease transgender girls into accepting that they will be happier in the long run by accepting their genetic maleness, since most of them will grow up to be gay men anyway.”

This is problematic. At this point the dude has gone beyond helping the kid figure out what/who they are, he’s trying to coerce them to the “right” identity. However you feel about kids transitioning, a therapist projecting onto them like this? That should be a problem.

1. Congress ain’t gonna impose such a ban. For better or for the worse.
2. Sexual orientation and gender identity are not the same, although they often involve similar stereotypes, prejudices and the like.
3. As I understand it, gender reassignment surgery is not something you just walk into a hospital and order. Their lots of preliminary medical testing/therapy involved. Two good friends of mine are/were transgender, although only one played on surgery.
4. Yes, tell

I agree with almost everything in this post. However I believe that the transgender-affirming mental health community is already aware of these concerns.

I was referred one time to look at the standards of care promoted by the World Professional Association for Transgender Health, http://www.wpath.org/

Every single right-originating “But what if…?” question you raise is, in my view, adequately answered by its professional standards (although I claim neutrality on its political ends). It has a very narrow, but clear and to the point definition of harmful therapies: “Treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success, particularly in the long term. Such treatment is no longer considered ethical.” (emphasis mine, references omitted)

Some of the key points to its recommended therapeutic approach are reducing the child’s or adolescent’s anxiety and helping families have a nurturing and accepting response to their child’s concerns. I happen to believe these approaches would have merit even in culturally restrictive societies and families. Let the parents set the rules.

Before we could even debate the morality of trying to change someone’s orientation, we would first need a therapy that actually works. That minimum bar to even have the moral debate of “should we” hasn’t been met.

The bottom line is that our sexual orientation, and our gender identity, are nobody else’s damned business in the first place.

We’re actually arguing about the particulars of a practice in which the general public obsesses over individuals’ private parts, where they can put them, and who they can or should love (?!?!).

What the hell is wrong with this picture? The other moral debates pale in comparison to the fact that it is none of anybody else’s business who you, or I, love, what sort of private parts we have, or how we use them.

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IGF CultureWatch is a blog that originated with the Independent Gay Forum, a group of writers and activists who focused on advancing gay and lesbian legal equality and social inclusion beyond ideological rigidity and leftwing orthodoxy. more